By Frances Ross, CTR - PowerPoint PPT Presentation

1 / 26
About This Presentation
Title:

By Frances Ross, CTR

Description:

1 tumor for Melanoma 2 tumors for Head and Neck - 1 tumor for Lung ... by site: Melanoma of the skin 1 tumor. There was one additional melanoma primary under ... – PowerPoint PPT presentation

Number of Views:49
Avg rating:3.0/5.0
Slides: 27
Provided by: naa3
Category:
Tags: ctr | frances | melanoma | ross

less

Transcript and Presenter's Notes

Title: By Frances Ross, CTR


1
Record Consolidation Test with the 2007 Multiple
Primary/Histology Rules
  • By Frances Ross, CTR
  • Presented at the
  • NAACCR Annual Conference
  • June, 2008

2
Background
  • First RC test analyzed the variability among
    registries in applying the MP rules in effect in
    2000
  • Created a test file of 743 source abstracts for
    320 patients
  • Source abstracts represented all types of
    reporting facilities and a broad range of cancer
    types
  • Abstracts were selected to test SEER MP rules
    (not a random or representative sample)

3
Background
  • An Expert Panel determined the correct number of
    primaries in the test file and the correct values
    for critical data fields the answer file
  • 11 central registries subjected the test file to
    their routine RC procedures and created their own
    answer file
  • The answer files were compared on count of
    primary tumors by person and by cancer type
  • The results were presented in a report to the
    Board and at the 2003 NAACCR Annual Conference

4
R C Test 2 - Purpose
  • Repeat the work of the first test, using the same
    test cases and the same general procedures
  • BUT
  • Apply the new 2007 Multiple Primary and Histology
    coding rules

5
R C Test 2 - Methods
  • Re-assembled a work group
  • Engaged a new Expert Panel
  • Selected all source abstracts for 236 patients
    from the original test file of 320 patients
  • Targeted cancers in the new MP/H site groupings
  • Not all of the Other sites cases were included
  • Experts again determined a correct answer file,
    of tumors for each person, showing diagnosis
    date, primary site, histology, behavior code,
    and laterality

6
R C Test 2 - Results
  • In total tumor counts, there were 4 fewer tumors
    under the 2007 MP/H rules
  • By cancer site, there were
  • 1 tumor for Melanoma
  • 2 tumors for Head and Neck
  • - 1 tumor for Lung
  • -2 tumors for urinary system
  • -4 tumors for other sites

7
R C Test 2 - Results
  • By person, there were 19 patients with different
    tumor counts

8
R C Test 2 Sample report
  • 111110019
  • Rules DX Date Site Lat Hist
    Beh Rule
  • --------------------------------------------------
    ---------------------------
  • Old Rules 11162001 C509 2 8500
    3 Rule 3
  • 04272002 C502 2 8500
    3 Rule 3
  • New Rules 11152001 C509 2 8500
    3 MP 11 Hist 27
  • 111115014
  • Rules DX Date Site Lat Hist
    Beh Rule
  • --------------------------------------------------
    ---------------------------
  • Old Rules 11202002 C509 1 8522
    3 Rule 5a, Exc 3
  • New Rules 11202002 C504 1 8520
    3 MP 12 Hist 1
  • 11202002 C505 1
    8514 3 MP 12 Hist 14
  • 111111102
  • Rules DX Date Site Lat Hist
    Beh Rule
  • --------------------------------------------------
    ---------------------------
  • Old Rules 07152003 C189 0 8220
    3 Rule 1
  • New Rules 07152003 C180 0
    8140 3 MP 11 Hist 11

9
R C Test 2 - Results
  • Results by site Melanoma of the skin 1 tumor
  • There was one additional melanoma primary under
    the 2007 rules. This was due to 2 lesions of the
    same site and histology, diagnosed at the same
    time, but one was on the left side of the chest
    and the other was at the midline.
  • Under the 2007 rules, midline tumors are counted
    as separate primaries from right and left sided
    tumors.

10
R C Test 2 - Results
  • Results by site Head and Neck 2 tumors
  • There were 2 patients, each with 1 additional
    tumor according to the 2007 MP/H rules.
  • This was due to the removal of the Same Site
    table formerly used under the previous SEER MP
    rules. One patient had lesions on the tonsil
    (C09.0) and oropharynx (C10.8) the other had
    lesions on the base of tongue (C01.9) and other
    parts of the tongue (C02.9). These are separate
    tumors in 2007.

11
R C Test 2 - Results
  • Results by site Breast - no change in total
    count
  • For the 4 patients with 1 fewer tumor each
  • - 3 had new tumors diagnosed within 5 years, so
    the change in the timing rule made these
    recurrences and not second primaries
  • - 1 had a different histology on biopsy from
    the mastectomy experts cited the most
    representative specimen instruction and coded
    this as one primary

12
R C Test 2 - Results
  • Results by site Breast (cont.)
  • For those patients with 1 additional tumor each
  • - 3 patients had ductal carcinoma and another
    type (tubular, medullary, desmoplastic type).
    These are not considered types of ductal
    carcinoma under the 2007 rules, so they are
    counted as separate primaries when found in
    separate tumors.
  • - 1 patient had tumors in both the right and
    left breast. It was originally interpreted as a
    metastasis, but since it was not explicitly
    stated as such, it was coded under the 2007 rules
    as a new primary.

13
R C Test 2 - Results
  • Results by site Lung -1 tumor
  • One patient had bilateral synchronous lung tumors
    two on the right side and one on the left.
    Only the right side was biopsied. The 2007 MP/H
    rules for lung include explicit statements
    regarding the number of tumors in each lung.
    This scenario fell to the last rule which states
    that it is to be considered one primary.

14
R C Test 2 - Results
  • Results by site Kidney and Urinary System -2
    tumors
  • Pre-2007 MP rules defined 2 site groupings
  • Bladder
  • Urinary system (kidney, renal pelvis, ureter,
    and other parts of the urinary tract)
  • 2007 MP/H rules define 2 site groupings
  • Kidney
  • Urinary system (bladder, renal pelvis, ureter,
    and other parts of the urinary tract)

15
R C Test 2 - Results
  • Results by site Kidney and Urinary System -2
    tumors
  • Two patients had 1 fewer tumor each
  • One had multiple tumors in the kidney and
    bladder, all diagnosed as PTCC. Since renal
    pelvis and bladder were in separate site
    groupings before 2007, this was 2 primaries.
    Under the 2007 rules, this is one site grouping
    and one primary.
  • One patient had PTCC of the ureter and 2 years
    later, PTCC of the bladder. The 2007 site
    groupings and timing rules make this one primary
    now.

16
R C Test 2 - Results
  • Results by site Other Sites grouping -4
    tumors
  • One patient with a gastroesophageal tumor had a
    recurrence 14 months later. Under the 2007 MP
    rules, this is a new primary.

17
R C Test 2 - Results
  • Results by site Other Sites grouping -4
    tumors
  • Two patients with VIN3 had recurrences within a
    year but not within 2 months. Under the 2007 MP
    timing rules, these are not new primaries.

18
R C Test 2 - Results
  • Results by site Other Sites grouping -4
    tumors
  • The patients with the small bowel and unknown
    primary cancers had very limited text. These
    cancer reports were interpreted differently by
    the second EP (not as new primaries), but this is
    not related to changes in the 2007 MP/H rules.

19
R C Test 2 Issues and Discussion
  • Histology coding changes
  • - code the final diagnosis from the most
    representative specimen
  • Breast
  • - new instructions regarding use of combination
    codes Table 2 defines ductal types
  • - instruction to invasive portion only
  • - code inflammatory carcinoma only from final
    path
  • - give precedence to comedocarcinoma if /2

20
R C Test 2 Issues and Discussion
  • Histology coding changes
  • Colon
  • - code 8210 if a polyp is mentioned
  • - use of 8220 (FAP) and 8221
  • Urinary
  • - confusion arose over which rule to use when
    biopsy says renal cell, clear cell and final
    path says renal cell carcinoma

21
R C Test 2 Issues and Discussion
  • Breast cancers The changes in MP rules resulted
    in more synchronous tumors and fewer subsequent
    tumors, so counts by diagnosis year could differ.
  • Urinary system Since bladder is now grouped
    with renal pelvis, ureter, and other urinary
    sites, there may be fewer primaries abstracted.
    A new question arose regarding which topography
    code to use for multiple tumors of the bladder
    and other urinary sites.

22
R C Test 2 Issues and Discussion
  • For example, which topography code should be used
    for multiple tumors of the bladder and another
    urinary site, i.e., ureter?
  • C67.__ Bladder
  • C66.9 Ureter
  • C68.8 Overlapping lesion of urinary organs
  • C68.9 Urinary system, NOS

23
R C Test 2 Issues and Discussion
  • Example (cont.)
  • If you code this scenario to C67._ (bladder) and
    the patient has a new bladder tumor after 3 yrs.,
    it is NOT a new primary, but
  • If you code this to C68._ (urinary system) and
    the patient has a new bladder tumor after 3 yrs.,
    it IS a new primary per rule M7. By using code
    C68 the information about which urinary sites
    were involved gets lost.

24
R C Test 2 Conclusion
  • - Study was a descriptive analysis of test cases
    (not a random or representative sample from a
    population)
  • - Identified specific scenarios where tumor
    counts will be different after 2007, especially
    by cancer site, but could not quantify impact
  • - Changes occur at patient level therefore
    counts by race and gender may be affected. POC
    and other studies will be affected as well, by
    the mix of tumor records available

25
R C Test 2 Recommendations
  • Specify additional site coding guidelines,
    particularly for urinary system
  • Review SEER site recode groupings, since they do
    not align with the 2007 MP/H site groupings
  • Develop RC guidelines for central cancer
    registries to
  • - identify the appropriate site specific rule
    set (i.e, solid tumors, benign brain,
    hematopoietic diseases)
  • - evaluate accuracy of data source to use during
    RC
  • - define how to handle situations with
    ambiguous, conflicting or insufficient
    information

26
Acknowledgements
  • Many thanks to the Record Consolidation Test
  • Experts and Work Group Members
  • Peggy Adamo, RHIT, CTR Jerri Linn Phillips, MA,
    CTR
  • NCI/SEER American College of Surgeons
  • Deborah Bringman, MPH Frances E. Ross, BA, CTR
  • University of California, Irvine Kentucky Cancer
    Registry
  • Susan J. Capron Wendy Scharber, RHIT, CTR
  • SEER Contractor Registry Widgets
  • Cynthia Dryer, BA, CTR John Young, Jr., DrPH,
    CTR
  • State Health Registry of Iowa Georgia SEER
    Registry
  • Fran Michaud, BS, CTR
  • CDC/NPCR
Write a Comment
User Comments (0)
About PowerShow.com